Prolonged post-recurrence survival following pleurectomy/decortication for malignant pleural mesothelioma
Prolonged post-recurrence survival following pleurectomy/decortication for malignant pleural mesothelioma
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DOI：
10.3892/ol.2019.9979
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发表时间：
2019-03-01
期刊：
影响因子：
2.9
通讯作者：
Okada, Morihito
中科院分区：
文献类型：
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作者：
Kai, Yuichiro;Tsutani, Yasuhiro;Okada, Morihito
本研究分析了恶性胸膜间皮瘤（MPM）患者行胸膜外全肺切除术（EPP）或胸膜切除/剥脱术（P/D）的手术结果。对44例在新辅助化疗后接受EPP（n=29）或P/D（n=15）后实现肉眼完全切除的患者的数据进行了审查。比较EPP组和P/D组的患者人口统计学和肿瘤学结局。中位总生存期（OS）和无进展生存期（PFS）分别为22个月和14个月。EPP和P/D组之间的OS存在显著差异（中位OS，17 vs. 34个月; 5年OS，11 vs. 44%; P=0.019）; PFS无差异（中位PFS，13 vs. 21个月; 5年PFS，11 vs. 17%; P=0.373）。单因素分析显示上皮组织学（P=0.0003）和P/D（P=0.018）是影响OS预后的重要因素，多因素分析显示上皮组织学（P=0.001）仍然是唯一有意义的因素。P/D组所有患者的复发后生存率（PRS）显著更长（中位PRS，3 vs 20个月; 1.5年PRS，5 vs 54%; P=0.003），即使在上皮型MPM患者中也是如此（中位PRS，6 s vs 20个月; 1.5年PRS，8 vs 61%; P=0.012）。多因素分析显示，复发后化疗（P=0.033）与上级PRS显著相关。P/D组术后肺功能明显改善。总之，对于可切除的MPM，P/D可能是EPP的替代手术，可提供相似的PFS和改善的PRS。
The present study analyzed surgical results in patients with malignant pleural mesothelioma (MPM) who underwent extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D). Data for 44 patients who achieved macroscopic complete resection following neoadjuvant chemotherapy followed by EPP (n=29) or P/D (n=15) were reviewed. Patient demographics and oncological outcomes were compared between the EPP and P/D groups. The median overall (OS) and progression-free survival (PFS) times were 22 and 14 months, respectively. OS was significantly different between the EPP and P/D groups (median OS, 17 vs. 34 months; 5-year OS, 11 vs. 44%; P=0.019); no difference was noted in PFS (median PFS, 13 vs. 21 months; 5-year PFS, 11 vs. 17%; P=0.373). Univariate analysis demonstrated that epithelial histology (P=0.0003) and P/D (P=0.018) were significant favorable prognostic factors for OS. Using multivariate analysis, epithelial histology (P=0.001) remained the only significant factor. Post-recurrence survival (PRS) among all patients was significantly longer in the P/D group (median PRS, 3 vs. 20 months; 1.5-year PRS, 5 vs. 54%; P=0.003), even among patients with epithelial-type MPM (median PRS, 6 s vs. 20 months; 1.5-year PRS, 8 vs. 61%; P=0.012). Chemotherapy following recurrence (P=0.033) was significantly associated with superior PRS in multivariate analysis. Postoperative pulmonary function was significantly improved in the P/D group. In summary, P/D may be an alternative procedure to EPP for resectable MPM providing similar PFS and improved PRS.